Healthcare Provider Details

I. General information

NPI: 1609022847
Provider Name (Legal Business Name): RAY ALTAMIRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 SE MILITARY DR STE 101
SAN ANTONIO TX
78223-4312
US

IV. Provider business mailing address

PO BOX 1342
LA VERNIA TX
78121-1342
US

V. Phone/Fax

Practice location:
  • Phone: 210-704-1777
  • Fax: 210-333-0775
Mailing address:
  • Phone: 210-912-1969
  • Fax: 210-966-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberP0535
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP0535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: